Heights University Hospital

All Charges

Charge

Type

Setting

Price

HEAD BIPOLAR SELF 28 MM 44 MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689575
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

HEAD BIPOLAR SELF 28 MM 44 MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689575
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

HEAD BIPOLAR SELF 28MMID41MMOD

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270657703
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

HEAD BIPOLAR SELF 28MMID41MMOD

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270657703
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,575.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

HEAD BIPOLAR SELFCTR 28X46MM

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270697314
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

HEAD BIPOLAR SELFCTR 28X46MM

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270697314
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,575.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

HEAD BIPOL SC 28MM ID/52MM OD

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270699294
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$750.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

HEAD BIPOL SC 28MM ID/52MM OD

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270699294
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

HEAD BIP SELF CEM 28MM 40MM OD

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270691719
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,500.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

HEAD BIP SELF CEM 28MM 40MM OD

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270691719
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

HEAD BIXCUT MOD REAMER 10.5MM

Facility

$2,610.00

Hospital Charge Code	270670462
Hospital Revenue Code	272
Min. Negotiated Rate	$339.30
Max. Negotiated Rate	$1,305.00
Rate for Payer: Aetna Commercial	$783.00
Rate for Payer: Aetna Medicare Advantage	$783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$665.55
Rate for Payer: Cigna Commercial	$1,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$339.30
Rate for Payer: Oxford Commercial	$1,305.00
Rate for Payer: Qualcare PPO/HMO/WC	$391.50
Rate for Payer: UnitedHealthcare Commercial	$1,305.00

HEAD BIXCUT MOD REAMER 10.5MM

Facility

$2,610.00

Hospital Charge Code	270670462
Hospital Revenue Code	272
Min. Negotiated Rate	$391.50
Max. Negotiated Rate	$391.50
Rate for Payer: Qualcare PPO/HMO/WC	$391.50

HEAD BIXCUT MOD REAMER 10MM

Facility

$2,610.00

Hospital Charge Code	270670461
Hospital Revenue Code	272
Min. Negotiated Rate	$339.30
Max. Negotiated Rate	$1,305.00
Rate for Payer: Aetna Commercial	$783.00
Rate for Payer: Aetna Medicare Advantage	$783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$665.55
Rate for Payer: Cigna Commercial	$1,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$339.30
Rate for Payer: Oxford Commercial	$1,305.00
Rate for Payer: Qualcare PPO/HMO/WC	$391.50
Rate for Payer: UnitedHealthcare Commercial	$1,305.00

HEAD BIXCUT MOD REAMER 10MM

Facility

$2,610.00

Hospital Charge Code	270670461
Hospital Revenue Code	272
Min. Negotiated Rate	$391.50
Max. Negotiated Rate	$391.50
Rate for Payer: Qualcare PPO/HMO/WC	$391.50

HEAD BIXCUT MOD REAMER 11.5MM

Facility

$2,610.00

Hospital Charge Code	270670464
Hospital Revenue Code	272
Min. Negotiated Rate	$391.50
Max. Negotiated Rate	$391.50
Rate for Payer: Qualcare PPO/HMO/WC	$391.50

HEAD BIXCUT MOD REAMER 11.5MM

Facility

$2,610.00

Hospital Charge Code	270670464
Hospital Revenue Code	272
Min. Negotiated Rate	$339.30
Max. Negotiated Rate	$1,305.00
Rate for Payer: Aetna Commercial	$783.00
Rate for Payer: Aetna Medicare Advantage	$783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$665.55
Rate for Payer: Cigna Commercial	$1,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$339.30
Rate for Payer: Oxford Commercial	$1,305.00
Rate for Payer: Qualcare PPO/HMO/WC	$391.50
Rate for Payer: UnitedHealthcare Commercial	$1,305.00

HEAD BIXCUT MOD REAMER 11MM

Facility

$2,610.00

Hospital Charge Code	270670463
Hospital Revenue Code	272
Min. Negotiated Rate	$339.30
Max. Negotiated Rate	$1,305.00
Rate for Payer: Aetna Commercial	$783.00
Rate for Payer: Aetna Medicare Advantage	$783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$665.55
Rate for Payer: Cigna Commercial	$1,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$339.30
Rate for Payer: Oxford Commercial	$1,305.00
Rate for Payer: Qualcare PPO/HMO/WC	$391.50
Rate for Payer: UnitedHealthcare Commercial	$1,305.00

HEAD BIXCUT MOD REAMER 11MM

Facility

$2,610.00

Hospital Charge Code	270670463
Hospital Revenue Code	272
Min. Negotiated Rate	$391.50
Max. Negotiated Rate	$391.50
Rate for Payer: Qualcare PPO/HMO/WC	$391.50

HEAD BIXCUT MOD REAMER 9.5MM

Facility

$2,610.00

Hospital Charge Code	270670460
Hospital Revenue Code	272
Min. Negotiated Rate	$339.30
Max. Negotiated Rate	$1,305.00
Rate for Payer: Aetna Commercial	$783.00
Rate for Payer: Aetna Medicare Advantage	$783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$665.55
Rate for Payer: Cigna Commercial	$1,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$339.30
Rate for Payer: Oxford Commercial	$1,305.00
Rate for Payer: Qualcare PPO/HMO/WC	$391.50
Rate for Payer: UnitedHealthcare Commercial	$1,305.00

HEAD BIXCUT MOD REAMER 9.5MM

Facility

$2,610.00

Hospital Charge Code	270670460
Hospital Revenue Code	272
Min. Negotiated Rate	$391.50
Max. Negotiated Rate	$391.50
Rate for Payer: Qualcare PPO/HMO/WC	$391.50

HEAD BIXCUT MOD REAMER 9MM

Facility

$2,610.00

Hospital Charge Code	270670459
Hospital Revenue Code	272
Min. Negotiated Rate	$339.30
Max. Negotiated Rate	$1,305.00
Rate for Payer: Aetna Commercial	$783.00
Rate for Payer: Aetna Medicare Advantage	$783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$665.55
Rate for Payer: Cigna Commercial	$1,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$339.30
Rate for Payer: Oxford Commercial	$1,305.00
Rate for Payer: Qualcare PPO/HMO/WC	$391.50
Rate for Payer: UnitedHealthcare Commercial	$1,305.00

HEAD BIXCUT MOD REAMER 9MM

Facility

$2,610.00

Hospital Charge Code	270670459
Hospital Revenue Code	272
Min. Negotiated Rate	$391.50
Max. Negotiated Rate	$391.50
Rate for Payer: Qualcare PPO/HMO/WC	$391.50

HEAD BMT MALL 13 170 11-104904

Facility

$26,310.00

Hospital Charge Code	270622582
Hospital Revenue Code	278
Min. Negotiated Rate	$3,946.50
Max. Negotiated Rate	$6,367.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,262.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,367.02
Rate for Payer: Qualcare PPO/HMO/WC	$3,946.50

HEAD BMT MALL 13 170 11-104904

Facility

$26,310.00

Hospital Charge Code	270622582
Hospital Revenue Code	278
Min. Negotiated Rate	$3,946.50
Max. Negotiated Rate	$13,155.00
Rate for Payer: Aetna Commercial	$7,893.00
Rate for Payer: Aetna Medicare Advantage	$7,893.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,709.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,709.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,262.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,709.05
Rate for Payer: Cigna Commercial	$13,155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,367.02
Rate for Payer: Qualcare PPO/HMO/WC	$3,946.50

HEAD BMT MALL 9 220 11-104958

Facility

$22,080.00

Hospital Charge Code	270611648
Hospital Revenue Code	278
Min. Negotiated Rate	$3,312.00
Max. Negotiated Rate	$11,040.00
Rate for Payer: Aetna Commercial	$6,624.00
Rate for Payer: Aetna Medicare Advantage	$6,624.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,630.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,630.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,416.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,630.40
Rate for Payer: Cigna Commercial	$11,040.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,343.36
Rate for Payer: Qualcare PPO/HMO/WC	$3,312.00

Know your out-of-pocket cost for care.

All Charges